Journal Club

    Dr. Kozlowski reviewed the Bouadma et al paper. It was really interesting to read and hear of the use of procalcitonin guided strategy to treat bacterial infections in non surgical patients in ICU and how it can reduce antibiotic exposure and selective pressure with no adverse outcomes . There were limitations - only 8 ICU s participated, surgical ICU patients represented only 10 percent of the population. Many Drs in the procalcitonin group did not follow the algorithm for d/c of antibiotics. 53% randomized the procalcitonin arm did not follow the algorithm treatment. A slightly higher number of patients in procalcitonin arm died between day 28 and 60. There was also no cost effectiveness analysis done. This study showed an interesting use of procalcitonin.

    Dr. Scorcese summarized the article by Simon Finfer et al. This international randomized trial found that intensive glucose (BS) control increased mortality in ICU adult patients. During the discussion it was noted when to treat BS and how. It was also discussed that NYS requires a BS less than 200 before arrival to ICU after cardiac surgery. The 90 day mortality from the two groups was discussed and compared in this study and p value noted to be < 0.001.

    Dr. Diamond gave a thorough review of Wiedemann et al. This study found no significant difference in primary outcome of 60 day mortality but conservative fluid management did improve lung function and shortened mechanical ventilation ICU care. During the discussion it was noted that the P value here was quite different compared to the NICE study. CVP pressure management was also discussed.